Introduction. Lean principles have been successfully adapted to the healthcare environment, enabling hospitals and clinics to streamline their operations and focus on value as perceived by their patients. Many healthcare facilities have implemented lean principles to improve their efficiency. The subject of this paper is the lean concept, the essence of which is implementation of methods that affect the efficiency and quality of providing health services. Our aim was to point out the necessity of applying modern concepts in healthcare. Material and Methods. The primary sources of data were obtained through research on the opinions and possibility of applying the lean concept in hospitals in Bosnia and Herzegovina. We presented the results on the effectiveness of the lean concept in hospitals that apply it. Results. After implementation of the lean concept in an Italian hospital, the results showed a positive impact on the waiting time for admission, faster discharge, and faster flow of information. The results of the research in Bosnia and Herzegovina showed that there were positive attitudes towards the effects that would be achieved by implementing the lean concept. Conclusion. The implementation of the lean concept would reduce medical waste, which would positively affect the quality of health care services.

The aim of our manuscript is to report of a successful perinatal outcome after treatment of acute polyhydramnios caused by duodenal atresia. A 34-year-old G3P1 was referred due to polyhydramnios in the 30th week of pregnancy. Ultrasound revealed polyhydramnios, amniotic fluid index (AFI) 28, and a double bubble sign that indicated duodenal atresia and dilatated oesophagus. In the 32nd week of gestation, the volume of amniotic fluid increases, AFI 35, along with symptoms of dyspnea and abdominal pain. Due to the clinical picture and the early gestational age, it was decided to perform an amnioreduction. In the 36th week of gestation cesarean section was performed. The baby was taken for exploratory laparotomy and found to have a simultaneous complete duodenal atresia and annular pancreas with associated dilated the first portion of the duodenum and the stomach. A side-to-side duodenoduodenostomy via single-layer hand-sewn anastomosis was performed over a transanastamotic feeding tube (TAFT). The postoperative course was uneventful. Amnioreduction is useful and safe in the treatment of acute polyhydramnios caused by duodenal atresia and thus has a significant role in prolonging gestation until fetal maturity.

Background: The etiology of preeclampsia has still not been completely explained. Early identification of women with the risk of developing preeclampsia is a key goal of antenatal care. Objective: To investigate risk factors for preeclampsia from the history, laboratory and ultrasound findings (Doppler). Methods: Pregnant women with normal Doppler sonography in the second trimester of pregnancy were classified as a control group, while pregnant women with impaired Doppler in the second trimester were considered as the investigated group with presumably increased risk for preeclampsia. A total number of 80 patients was included in the study (40 patients in each group). Results: The difference of urea, uric acid and lactate dehydrogenase (LDH) in the serum of the control and investigated group was statistically significant, while the differences were not statistically significant for creatinine, aspartate aminotransferase (AST) and alanine aminotransferase (ALT). The presence of a notch sign during assessment of blood flow in uterine arteries in subjects in the investigated group with the diagnosis of preeclampsia had the specificity of 47.62%, and sensitivity of 88.89%. The positive predictive value of a notch sign during assessment of blood flow in uterine arteries as a marker for diagnosis of preeclampsia in the second trimester of pregnancy was 90.91%, and its negative. Systolic and diastolic blood pressure are dependent variables which are predicting preeclampsia, whilst a notch sign in uterine arteries was designated as an independent variable predicting preeclampsia. Conclusion: From the laboratory tests the following parameters were considered as the risk factors for preeclampsia: increasing levels of urea, uric acid, and LDH. Notch sign was considered to be a very strong predictor of preeclampsia, especially if present bilaterally. Doppler sonography in the second trimester of pregnancy is a good predictor for early diagnosis of preeclampsia.

Purpose: To evaluate the results of the Kurjak antenatal neurodevelopmental test (KANET) in multicentric studies. Materials and methods: In KANET, normal, borderline, and abnormal fetuses postnatal development was followed. The Chi-square was considered significant if p < 0.05 was used in the statistical analysis. Specificity, sensitivity, prevalence, positive and negative predictive value, false-positive, and false-negative results were calculated. Results: In 3,709 singleton fetuses, KANET was assessed. Postnatal follow-up was available for 1,556 of 1,573 (42.4%) infants. For 2,136, the data were not available. Interrater reliability (κ coefficient) for low-risk fetuses was between 0.64 and 0.65 (agreement 94.2–97.3%), for high-risk fetuses was between 0.44 and 0.53 (agreement 70.5–78.9%), respectively. Borderline KANET was found in 153 (9.7%), abnormal in 52 (3.3%), both more prevalent in high-risk pregnancies ( χ 2 = 457.36; df = 2; p < 0.01). Abnormal KANET was connected with severe postnatal developmental delay ( χ 2 = 315.28; df = 6; p < 0.01). In 47 out of 1,102 children aged 2 years and more, abnormal KANET was found, among them in one with CP. In 1 out of 1,055 children with normal KANET, severe developmental delay was found. The KANET has low sensitivity for detection of developmental delay and CP. The KANET specificity is high for all tested variables, positive predictive value and the false-positive rate are high, the negative predictive value is high (99.77–99.95%), and the false-negative rate is low (0.23–0.05%). Conclusion: With normal KANET, there is a high probability of normal infant development. If the KANET score is borderline or abnormal in high-risk pregnancies, postnatal development may appear abnormal.